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Butin S, Griffoul I, Espitalier F, Salamé E, Mulleman D, Goupille P. High incidence of vertebral osteoporotic fracture within the first year after liver transplantation. Clin Exp Rheumatol 2017; 35:913-918. [PMID: 28516878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Bone loss is a complication for patients with liver diseases and after transplantation, which results in increased fracture risk. The aim of this study was to determine the incidence of osteoporotic vertebral fractures following liver transplantation. METHODS We performed a prospective study of patients who were awaiting liver transplantation. Patients were seen at baseline (visit 1) and one year after transplantation (visit 2). At each visit, risk factors of osteoporosis were collected, biochemical tests were performed and bone mineral density with Vertebral Fracture Assessment was assessed. RESULTS One hundred and fifteen patients were in the pre-transplant group and 33 patients were in the post-transplant group. In the pre-transplant group, the prevalence of vertebral fractures was 23.5%. The prevalence of densitometric osteoporosis was higher at the lumbar spine than at the femoral neck. In the post-transplant group, the prevalence of vertebral fractures at visit 1 and visit 2 was 33.3% and 60.6% respectively with an incidence of 23.1 fractures per 100 patient-years. CONCLUSIONS Bone fragility was highly prevalent before transplantation and worsens one year after transplantation. Bone status should be evaluated in patients with liver diseases before transplantation to identify patients at high risk of fracture and help clinicians to prescribe appropriate preventive care.
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Affiliation(s)
- Sarah Butin
- Department of Rheumatology, CHRU de Tours, France
| | | | | | - Ephrem Salamé
- Department of Hepatobiliary Surgery and Transplantation, CHRU de Tours; and Université François-Rabelais de Tours, France
| | - Denis Mulleman
- Department of Rheumatology, CHRU de Tours; and Université François-Rabelais de Tours, France
| | - Philippe Goupille
- Department of Rheumatology, CHRU de Tours; and Université François-Rabelais de Tours, France
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Altieri M, Delaval G, Kimmoun E, Allaire M, Salamé E, Dumortier J. Conversion From Once-Daily Prolonged-Release Tacrolimus to Once-Daily Extended-Release Tacrolimus in Stable Liver Transplant Recipients. EXP CLIN TRANSPLANT 2017; 16:321-325. [PMID: 28697715 DOI: 10.6002/ect.2016.0328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES After organ transplant, strategies to simplify the therapeutic regimen may improve adherence and prevent rejection and/or graft loss. The aim of the present study was to evaluate the safety of conversion from once-daily prolonged-release tacrolimus (Advagraf; Astellas Pharma Europe Limited, Middlesex, UK) to once-daily extended-release tacrolimus (Envarsus; Chiesi SAS, Nanterre, France) in stable adult liver transplant recipients. MATERIALS AND METHODS This observational study inclu-ded 44 liver transplant patients (median age of 59 y; 63.6% men; median delay after transplant of 72.5 mo). Conversion was based on a 1:0.70 proportion. RESULTS Mean dose of tacrolimus was 2.65 ± 1.24 mg/day before conversion and 2.09 ± 1.68 mg/day after conversion (P < .05), with ratio of 1:0.79. Mean serum tacrolimus trough level increased after conversion (4.92 ± 1.65 vs 5.60 ± 2.89 ng/mL; P < .05), with ratio of 1:1.14. Six months after conversion, mean dose of tacrolimus was 1.65 ± 0.93 mg/day (ratio of 1:0.62) and mean serum tacrolimus trough level was 4.82 ± 1.85 ng/mL, similar to the initial level before conversion. At the end of follow-up, 2 patients had returned to once-daily prolonged-release tacrolimus because of adverse effects (allergy, digestive trouble), which resolved thereafter. The mean cost of tacrolimus therapy was 5.54 ± 2.29 Euros/patient/day before conversion and 4.11 ± 2.32 Euros/patient/day after conversion (P < .05). CONCLUSIONS Conversion from prolonged-release to extended-release tacrolimus in stable liver transplant patients is safe and cost-effective; however, initially, dose adaptations and careful monitoring are required.
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Affiliation(s)
- Mario Altieri
- >From the service d'Hépato-Gastroentérologie, Nutrition et Oncologie Digestive, Hôpital Côte de Nacre, Caen, France
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Saliba F, Duvoux C, Gugenheim J, Kamar N, Dharancy S, Salamé E, Neau-Cransac M, Durand F, Houssel-Debry P, Vanlemmens C, Pageaux G, Hardwigsen J, Eyraud D, Calmus Y, Di Giambattista F, Dumortier J, Conti F. Efficacy and Safety of Everolimus and Mycophenolic Acid With Early Tacrolimus Withdrawal After Liver Transplantation: A Multicenter Randomized Trial. Am J Transplant 2017; 17:1843-1852. [PMID: 28133906 DOI: 10.1111/ajt.14212] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 01/25/2023]
Abstract
SIMCER was a 6-mo, multicenter, open-label trial. Selected de novo liver transplant recipients were randomized (week 4) to everolimus with low-exposure tacrolimus discontinued by month 4 (n = 93) or to tacrolimus-based therapy (n = 95), both with basiliximab induction and enteric-coated mycophenolate sodium with or without steroids. The primary end point, change in estimated GFR (eGFR; MDRD formula) from randomization to week 24 after transplant, was superior with everolimus (mean eGFR change +1.1 vs. -13.3 mL/min per 1.73 m2 for everolimus vs. tacrolimus, respectively; difference 14.3 [95% confidence interval 7.3-21.3]; p < 0.001). Mean eGFR at week 24 was 95.8 versus 76.0 mL/min per 1.73 m2 for everolimus versus tacrolimus (p < 0.001). Treatment failure (treated biopsy-proven acute rejection [BPAR; rejection activity index score >3], graft loss, or death) from randomization to week 24 was similar (everolimus 10.0%, tacrolimus 4.3%; p = 0.134). BPAR was more frequent between randomization and month 6 with everolimus (10.0% vs. 2.2%; p = 0.026); the rate of treated BPAR was 8.9% versus 2.2% (p = 0.055). Sixteen everolimus-treated patients (17.8%) and three tacrolimus-treated patients (3.2%) discontinued the study drug because of adverse events. In conclusion, early introduction of everolimus at an adequate exposure level with gradual calcineurin inhibitor (CNI) withdrawal after liver transplantation, supported by induction therapy and mycophenolic acid, is associated with a significant renal benefit versus CNI-based immunosuppression but more frequent BPAR.
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Affiliation(s)
- F Saliba
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Villejuif, France
| | - C Duvoux
- Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Henri Mondor, Créteil, France
| | - J Gugenheim
- Département de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, University of Nice Sophia Antipolis, Nice, France
| | - N Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, Toulouse, France
| | - S Dharancy
- Service d'Hépato-Gastroentérologie, CHRU de Lille, Lille, France
| | - E Salamé
- Service de Chirurgie Hépato-Biliaire et Digestive, Hôpital Trousseau, CHU Tours, Tours, France
| | - M Neau-Cransac
- Unité de Chirurgie Biliaire et de Transplantation Hépatique, Hôpital Magellan, CHU Bordeaux, Pessac, France
| | - F Durand
- Service d'Hépatologie et Transplantation Hépatique, University Paris Diderot, INSERM U1149, Clichy, France
| | - P Houssel-Debry
- Service de Chirurgie Hépatobiliaire et Digestive, CIC 1414, Hôpital Pontchaillou, Rennes, France
| | - C Vanlemmens
- Service d'Hépatologie et Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
| | - G Pageaux
- Service Hépato-Gastroentérologie, Hôpital Saint Eloi, Montpellier, France
| | - J Hardwigsen
- Service de Chirurgie et Transplantation Hépatique, Hôpital la Timone, Marseille, France
| | - D Eyraud
- Département d'Anesthésie-Réanimation, Service de Chirurgie Digestive et Hépato-Biliaire et de Transplantation Hépatique, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Y Calmus
- Service de Chirurgie Digestive et Hépato-Biliaire, Transplantation Hépatique, AP-HP Hôpital Pitié Salpêtrière, Paris, France
| | | | - J Dumortier
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France
| | - F Conti
- Service de Chirurgie Digestive et Hépato-Biliaire, Transplantation Hépatique, AP-HP Hôpital Pitié Salpêtrière, Paris, France
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Costentin CE, Amaddeo G, Decaens T, Boudjema K, Bachellier P, Muscari F, Salamé E, Bernard PH, Francoz C, Dharancy S, Vanlemmens C, Radenne S, Dumortier J, Hilleret MN, Chazouillères O, Pageaux GP, Calderaro J, Laurent A, Roudot-Thoraval F, Duvoux C. Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant-based prognostic models. Liver Int 2017; 37:717-726. [PMID: 28199760 DOI: 10.1111/liv.13388] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Abstract
AIM Discordance between pre-LT imaging and explanted liver findings have been reported after liver transplantation (LT) for hepatocellular carcinoma (HCC), suggesting the need of reassessing the risk of HCC recurrence post-LT. Our aims were to compare pre-LT imaging and explants features and to test the performances of four explant-based predictive models of recurrence in an external cohort. METHODS Staging according to pre-LT imaging and explant features were compared. Four explants-based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared. RESULTS Pre-LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUCs for prediction of 5-years recurrence were observed in the "Up to seven" (0.7915 [95% CI: 0.7339-0.849]) and Decaens models (0.747 [95% CI: 0.6877-0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUCs (0.68 and 0.70) respectively. Accuracy of the "Up to seven" model was superior to the Decaens model (P=.034), which was superior to the Chan model (P=.0041) but not to the Iwatsuki model (P=.17). CONCLUSION Pre-LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT. The explant-based "Up to seven" and Decaens models provided the best accuracy for prediction of 5-year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT.
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Affiliation(s)
| | | | - Thomas Decaens
- Service d'hépatologie, CHU Grenoble Alpes, Grenoble, France
| | - Karim Boudjema
- Service de Chirurgie digestive, Hôpital Pontchaillou, Rennes, France
| | | | - Fabrice Muscari
- Service de Chirurgie digestive, Hôpital Rangueil, Toulouse, France
| | - Ephrem Salamé
- Service de Chirurgie digestive, CHU de Tours, Chambray-lès-Tours, France
| | | | | | | | | | - Sylvie Radenne
- Service d'hépatologie, Hôpital Lyon Croix Rousse, Lyon, France
| | - Jérôme Dumortier
- Service d'hépatologie, Hospices Civiles de Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | | | | | - Julien Calderaro
- Département de Pathologie, Hôpital Henri Mondor, Créteil, France
| | - Alexis Laurent
- Service de Chirurgie digestive, Hôpital Henri Mondor, Créteil, France
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Dumortier J, Dharancy S, Calmus Y, Duvoux C, Durand F, Salamé E, Saliba F. Use of everolimus in liver transplantation: The French experience. Transplant Rev (Orlando) 2016; 30:161-70. [DOI: 10.1016/j.trre.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/14/2015] [Indexed: 12/18/2022]
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Chiche L, David A, Adam R, Oliverius MM, Klempnauer J, Vibert E, Colledan M, Lerut J, Mazzafero VV, Di-Sandro S, Laurent C, Scuderi V, Suc B, Troisi R, Bachelier P, Dumortier J, Gugenheim J, Mabrut JY, Gonzalez-Pinto I, Pruvot FR, Le-Treut YP, Navarro F, Ortiz-de-Urbina J, Salamé E, Spada M, Bioulac-Sage P. Liver transplantation for adenomatosis: European experience. Liver Transpl 2016; 22:516-26. [PMID: 26919265 DOI: 10.1002/lt.24417] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to collect data from patients who underwent liver transplantation (LT) for adenomatosis; to analyze the symptoms, the characteristics of the disease, and the recipient outcomes; and to better define the role of LT in this rare indication. This retrospective multicenter study, based on data from the European Liver Transplant Registry, encompassed patients who underwent LT for adenomatosis between January 1, 1986, and July 15, 2013, in Europe. Patients with glycogen storage disease (GSD) type IA were not excluded. This study included 49 patients. Sixteen patients had GSD, and 7 had liver vascular abnormalities. The main indications for transplantation were either a suspicion of hepatocellular carcinoma (HCC; 15 patients) or a histologically proven HCC (16 patients), but only 17 had actual malignant transformation (MT) of adenomas. GSD status was similar for the 2 groups, except for age and the presence of HCC on explants (P = 0.030). Three patients with HCC on explant developed recurrence after transplantation. We obtained and studied the pathomolecular characteristics for 23 patients. In conclusion, LT should remain an extremely rare treatment for adenomatosis. Indications for transplantation primarily concern the MT of adenomas. The decision should rely on morphological data and histological evidence of MT. Additional indications should be discussed on a case-by-case basis. In this report, we propose a simplified approach to this decision-making process.
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Affiliation(s)
- Laurence Chiche
- Chirurgie Hépatobiliaire et Pancréatique, Centre Hospitalier Universitaire Bordeaux, Maison du Haut Lévèque, Bordeaux, France
| | - Anaelle David
- Chirurgie Hépatobiliaire et Pancréatique, Centre Hospitalier Universitaire Bordeaux, Maison du Haut Lévèque, Bordeaux, France
| | - René Adam
- ELTR and ELITA Board. www.eltr.org.,Centre Hépato-Biliaire, INSERM U785, Hôpital Paul Brousse, Villejuif, France
| | - M Martin Oliverius
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,ELTR and ELITA Board. www.eltr.org
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hanover, Germany
| | - Eric Vibert
- Centre Hépato-Biliaire, INSERM U785, Hôpital Paul Brousse, Villejuif, France
| | - Michele Colledan
- Department of Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Jan Lerut
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - V Vincenzo Mazzafero
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Istituto Nazionale Tumori IRCCS Foundation, Milan, Italy
| | - Stefano Di-Sandro
- Department of General Surgery and Transplantation, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Christophe Laurent
- Chirurgie Hépatobiliaire et Pancréatique, Centre Hospitalier Universitaire Bordeaux, Maison du Haut Lévèque, Bordeaux, France
| | - Vincenzo Scuderi
- Department of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Bertrand Suc
- Chirurgie Générale et Digestive, Hôpital de Rangueil, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Roberto Troisi
- Department of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Phillipe Bachelier
- Hôpital de Haute Pierre, Service de Chirurgie Hépatique et Transplantation, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Jerôme Dumortier
- Service d'Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - Jean Gugenheim
- Service de Chirurgie Digestive et Centre de Transplantation Hépatique de l'Hôpital de l'Archet, Centre Hospitalier Universitaire Nice, Nice, France
| | - Jean-Yves Mabrut
- Chirurgie Générale et Digestive et de la Transplantation Hépatique et Intestinale, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - Ignacio Gonzalez-Pinto
- General and Digestive Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Yves Patrice Le-Treut
- Chirurgie Générale et digestive, Hôpital de la Conception, Centre Hospitalier Universitaire Marseille, Marseille, France
| | - Francis Navarro
- Chirurgie Digestive, Hôpital Saint Eloi, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Jorge Ortiz-de-Urbina
- Hepato-Biliary Surgery and Liver Transplantation Unit, Hospital Universitario de Cruces, Bilbao, Spain
| | - Ephrem Salamé
- Chirurgie Hépato-Biliaire et Digestive, Centre Hospitalier Universitaire Tours
| | - Marco Spada
- Instituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, Palermo, Italy
| | - Paulette Bioulac-Sage
- Service de Pathologie, INSERM U1053, Université Bordeaux Segalen, Hôpital Pellegrin, Bordeaux, France
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Goumard C, Cachanado M, Herrero A, Rousseau G, Dondero F, Compagnon P, Boleslawski E, Mabrut JY, Salamé E, Soubrane O, Simon T, Scatton O. Biliary reconstruction with or without an intraductal removable stent in liver transplantation: study protocol for a randomized controlled trial. Trials 2015; 16:598. [PMID: 26719017 PMCID: PMC4696210 DOI: 10.1186/s13063-015-1139-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of biliary complications following liver transplantation (LT) remains high, ranging from 10 to 50 % of patients, especially when the diameter of the bile duct is smaller than 7 mm. Biliary reconstruction is most often performed by duct-to-duct anastomosis. In a preliminary study (n = 20), we previously reported a technique of biliary reconstruction using an intraductal stent tube followed by its endoscopic removal and showed both the feasibility and safety of this innovative procedure. The next step is to validate the potential benefit of this procedure in a randomized controlled trial. Design This is a multicenter randomized controlled trial in France comparing the efficacy of biliary reconstruction with or without a removable intraductal stent on reducing biliary complications. Inclusion and randomization are performed during LT when a duct-to-duct biliary anastomosis smaller than 7 mm in diameter is envisioned. In the intraductal stent group, a custom-made segment of a T-tube is placed into the bile duct and removed endoscopically 4 to 6 months later. The surgical technique is described in a video during randomization and is available on the secure website used for inclusion and randomization. The primary endpoint is the occurrence of biliary complications, including biliary fistulae and strictures, during the 6 months of follow-up. Secondary evaluation criteria are the incidence of complications related to the stent placement and its extraction by endoscopy. The inclusion of 248 patients in total has been determined based on an expected incidence of biliary complications of 25 % in the non-IST group and a 60 % reduction of biliary complications (10 %) in the IST group. Discussion Biliary complications following LT are significant causes of morbidity, retransplantation, and mortality. Although controversial, the use of a T-tube has been proven to be useless and even responsible for specific complications related to the external part of the tube in many studies, including several randomized trials. However, several studies have identified a small bile duct diameter as a risk factor for biliary stenosis. A threshold of 7 mm was found to be significantly associated with biliary stenosis. Our team published a preliminary study that included 20 patients using a new technique of intraductal stenting. Only four complications were reported in the overall study population, whereas no biliary complication occurred in the subgroup of patients who received a whole graft LT. Moreover, no technical failures and no procedure-related complications were noted before and during the drain removal. Although an intraductal stent tube in duct-to duct biliary anastomosis seems feasible and safe, a multicenter randomized controlled trial is needed to validate its benefit as a protective tool against the occurrence of biliary complications. One original aspect of this protocol is the video demonstration of the surgical procedure, which is available on the web to standardize and homogenize the technique. The surgical community may be inspired by this type of tool in the future to minimize technical bias related to technical issues. Trial registration NCT02356939, date of registration 2 February 2015.
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Affiliation(s)
- Claire Goumard
- Hepatobiliary surgery and liver transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpétrière, UPMC-Paris 06, Paris, France.
| | - Marine Cachanado
- Department of Clinical Pharmacoloy, APHP, Hôpital St Antoine, Unité de Recherche Clinique de l'Est Parisien (URCEST), UPMC-Paris 06, Paris, France.
| | - Astrid Herrero
- Hepatobiliary surgery and liver transplantation, CHR Montpellier, Montpellier, France.
| | - Géraldine Rousseau
- Hepatobiliary surgery and liver transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpétrière, UPMC-Paris 06, Paris, France
| | - Federica Dondero
- Hepatobiliary surgery and liver transplantation, APHP, Hôpital Beaujon, Clichy, France.
| | - Philippe Compagnon
- Hepatobiliary surgery and liver transplantation, APHP, Hôpital Henri Mondor, Creteil, France.
| | | | - Jean Yves Mabrut
- Hepatobiliary surgery and liver transplantation, Hopital Edouard Herriot, Lyon, France.
| | - Ephrem Salamé
- Hepatobiliary surgery and liver transplantation, CHR Tours, Tours, France.
| | - Olivier Soubrane
- Hepatobiliary surgery and liver transplantation, APHP, Hôpital Beaujon, Clichy, France
| | - Tabassome Simon
- Department of Clinical Pharmacoloy, APHP, Hôpital St Antoine, Unité de Recherche Clinique de l'Est Parisien (URCEST), UPMC-Paris 06, Paris, France
| | - Olivier Scatton
- Hepatobiliary surgery and liver transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpétrière, UPMC-Paris 06, Paris, France.
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Butin S, Griffoul I, Martaillé V, Marot M, Lauferon F, Salamé E, Mulleman D, Goupille P. AB0907 Bone Status of Transplant Patients with Chronic Liver Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pascher A, De Simone P, Pratschke J, Salamé E, Pirenne J, Isoneimi H, Bijarnia M, Krishnan I, Klupp J. Protein kinase C inhibitor sotrastaurin in de novo liver transplant recipients: a randomized phase II trial. Am J Transplant 2015; 15:1283-92. [PMID: 25677074 DOI: 10.1111/ajt.13175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/30/2014] [Accepted: 11/16/2014] [Indexed: 01/25/2023]
Abstract
Efficacy and safety of protein kinase C inhibitor sotrastaurin (STN) with tacrolimus (TAC) was assessed in a 24-month, multicenter, phase II study in de novo liver transplant recipients. A total of 204 patients were randomized (1:1:1:1) to STN 200 mg b.i.d. + standard-exposure TAC (n = 50) or reduced-exposure TAC (n = 52), STN 300 mg b.i.d. + reduced-exposure TAC (n = 50), or mycophenolate mofetil (MMF) 1 g b.i.d. + standard-exposure TAC (control, n = 52); all with steroids. Owing to premature study termination, treatment comparisons were only conducted for Month 6. At Month 6, composite efficacy failure rates (treated biopsy-proven acute rejection episodes of Banff grade ≥1, graft loss, or death) were 25.0%, 16.5%, 20.9% and 15.9% for STN 200 mg + standard TAC, STN 200 mg + reduced TAC, STN 300 mg + reduced TAC and control groups, respectively. Median estimated glomerular filtration rates were 84.0, 83.3, 81.1 and 75.3 mL/min/1.73 m(2), respectively. Gastrointestinal events (constipation, diarrhea, and nausea), infection, and tachycardia were more frequent in STN groups. More patients in STN groups experienced serious adverse events compared with the control group (62.3-70.8% vs. 51.9%). STN-based regimens were associated with a higher efficacy failure rate and higher incidence of adverse events with no significant difference in renal function between the groups.
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Affiliation(s)
- A Pascher
- Charité - Universitaetsmedizin Berlin, Berlin, Germany
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Dumortier J, Salamé E, Roche B, Hurtova M, Conti F, Radenne S, Vanlemmens C, Pageaux GP, Saliba F, Samuel D, Compagnon P, Neau-Cransac M, Calmus Y, Guillaud O, Gugenheim J, Altieri M, Durand F, Hardwigsen J, Lorho R, Dharancy S, Leroy V, Di Giambattista F, Duvoux C. Severe fibrosis in patients with recurrent hepatitis C after liver transplantation: a French experience on 250 patients over 15 years (the Orfèvre study). Clin Res Hepatol Gastroenterol 2014; 38:292-9. [PMID: 24685602 DOI: 10.1016/j.clinre.2014.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/27/2014] [Accepted: 02/18/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Recurrent hepatitis C after liver transplantation (LT) is associated with rapid fibrosis progression. The aim of this study was to evaluate the cumulative risk for severe fibrosis and the factors influencing it. PATIENTS AND METHODS Two hundred and fifty LT patients were included 1 to 15years after LT. Recurrence of chronic hepatitis C on liver graft was classified according to Metavir score. RESULTS Kaplan-Meyer estimates for actuarial progression to severe fibrosis (Metavir>F3) showed a probability of 15.2% and 44.5% at 5 and 10years, respectively. Predictive factors for progression to severe fibrosis were: use of tacrolimus as main CNI, recipient age at time of biopsy<55, donor age ≥45, graft HCV re-infection<3months, biologically suspected graft re-infection and lack of response to antiviral treatment after LT. Multivariate analysis disclosed that only donor age ≥45 (hazard ratio 2.243, 95%CI 1.264-3.983, P=0.0058) and lack of response to antiviral treatment (hazard ratio 2.816, 95%CI 1.227-6.464, P=0.0146) were associated to severe fibrosis. CONCLUSIONS Our study confirms that donor age ≥45 and lack of response to antiviral treatment after LT are major predictive factors of progression of HCV recurrence on liver graft.
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Affiliation(s)
- Jérôme Dumortier
- Unité de transplantation hépatique-fédération des spécialités digestives, HCL, pavillon D, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France.
| | - Ephrem Salamé
- Service de chirurgie digestive et transplantation hépatique, hôpital Trousseau, 37170 Chambray-lès-Tours, France
| | - Bruno Roche
- Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France
| | - Monika Hurtova
- Service d'hépatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Filomena Conti
- Service de chirurgie, hôpital Cochin, AP-HP, 75014 Paris, France
| | - Sylvie Radenne
- Service d'hépatologie, HCL, hôpital de la Croix-Rousse, 69205 Lyon, France
| | - Claire Vanlemmens
- Service d'hépatologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon, France
| | - Georges-Philippe Pageaux
- Fédération médico-chirurgicale des maladies de l'appareil digestif, hôpital Saint-Eloi, 34295 Montpellier, France
| | - Faouzi Saliba
- Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France
| | - Didier Samuel
- Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France
| | - Philippe Compagnon
- Service de chirurgie digestive et hépato-biliaire - transplantation hépatique, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | | | - Yvon Calmus
- Service de chirurgie, hôpital Cochin, AP-HP, 75014 Paris, France
| | - Olivier Guillaud
- Unité de transplantation hépatique-fédération des spécialités digestives, HCL, pavillon D, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France
| | - Jean Gugenheim
- Service de chirurgie digestive, hôpital L'Archet 2, CHU de Nice, 06202 Nice, France
| | - Mario Altieri
- Service de chirurgie digestive, CHU de Côte de Nacre, 14033 Caen, France
| | - François Durand
- Service d'hépatologie, hôpital Beaujon, AP-HP, 92118 Clichy, France
| | - Jean Hardwigsen
- Service de chirurgie digestive, hôpital la Conception, 13385 Marseille, France
| | - Richard Lorho
- Service de chirurgie hépato-biliaire et digestive, hôpital de Pontchaillou, 35033 Rennes, France
| | | | - Vincent Leroy
- Service d'hépato-gastro-entérologie, hôpital A.-Michallon, 38700 La Tronche, France
| | | | - Christophe Duvoux
- Service d'hépatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
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Guillaud O, Dumortier J, Sobesky R, Debray D, Wolf P, Vanlemmens C, Durand F, Calmus Y, Duvoux C, Dharancy S, Kamar N, Boudjema K, Bernard PH, Pageaux GP, Salamé E, Gugenheim J, Lachaux A, Habes D, Radenne S, Hardwigsen J, Chazouillères O, Trocello JM, Woimant F, Ichai P, Branchereau S, Soubrane O, Castaing D, Jacquemin E, Samuel D, Duclos-Vallée JC. Long term results of liver transplantation for Wilson's disease: experience in France. J Hepatol 2014; 60:579-89. [PMID: 24211743 DOI: 10.1016/j.jhep.2013.10.025] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/14/2013] [Accepted: 10/23/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). We aimed to report on the long-term outcome of WD patients following LT. METHODS The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 years, (18-66)) and 46 were children (median age: 14 years, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n = 64, 53%), median age = 16 years (7-53), (2) decompensated cirrhosis (n = 50, 41%), median age = 31.5 years (12-66) or (3) severe neurological disease (n = 7, 6%), median age = 21.5 years (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). RESULTS Actuarial patient survival rates were 87% at 5, 10, and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure, and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis. In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pretransplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 ml/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. CONCLUSIONS Liver failure associated with WD is a rare indication for LT (<1%), which achieves an excellent long-term outcome, including renal function.
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Affiliation(s)
- Olivier Guillaud
- Centre National de Référence de la Maladie de Wilson/Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Jérôme Dumortier
- Centre National de Référence de la Maladie de Wilson/Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Rodolphe Sobesky
- Centre National de Référence de la Maladie de Wilson/Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; UMR 785, INSERM, France; UMR-S 785, Univ Paris-Sud, Villejuif, France; DHU Hepatinov, Villejuif, France
| | - Dominique Debray
- Service d'Hépatologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Philippe Wolf
- Service de Chirurgie générale et Transplantation, Hôpital Hautefeuille, CHU Strasbourg, France
| | | | - François Durand
- Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Yvon Calmus
- Service de Chirurgie, Hôpital Cochin, AP-HP, Paris, France
| | | | - Sébastien Dharancy
- Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Nassim Kamar
- Service de Néphrologie-Hypertension artérielle-Dialyse-Transplantation, Hôpital Rangueil, CHU de Toulouse, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital de Pontchaillou, CHU de Rennes, France
| | - Pierre Henri Bernard
- Service d'Hépatologie et de Gastroentérologie, Hôpital Pellegrin, Bordeaux, France
| | - Georges-Philippe Pageaux
- Fédération Médico-Chirurgicale des Maladies de l'Appareil Digestif, Hôpital Saint-Eloi, Montpellier, France
| | - Ephrem Salamé
- Service de Chirurgie Digestive, CHU Bretonneau, Tours, France
| | - Jean Gugenheim
- Service de Chirurgie Digestive, Hôpital L'Archet (2), CHU Nice, Nice, France
| | - Alain Lachaux
- Centre National de Référence de la Maladie de Wilson/Service de Pédiatrie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Dalila Habes
- Centre National de Référence de la Maladie de Wilson/Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; DHU Hepatinov, Villejuif, France
| | - Sylvie Radenne
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices civils de Lyon, Lyon, France
| | - Jean Hardwigsen
- Service de Chirurgie Digestive, Hôpital la Conception, Marseille, France
| | | | - Jean-Marc Trocello
- Centre National de Référence de la Maladie de Wilson/Service de Neurologie, Hôpital Lariboisière, AP-HP, Paris, France
| | - France Woimant
- Centre National de Référence de la Maladie de Wilson/Service de Neurologie, Hôpital Lariboisière, AP-HP, Paris, France
| | - Philippe Ichai
- Centre National de Référence de la Maladie de Wilson/Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; UMR 785, INSERM, France; UMR-S 785, Univ Paris-Sud, Villejuif, France; DHU Hepatinov, Villejuif, France
| | - Sophie Branchereau
- Centre National de Référence de la Maladie de Wilson/Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; DHU Hepatinov, Villejuif, France
| | - Olivier Soubrane
- Service de chirurgie hépatobiliaire et transplantation hépatique, Hôpital St Antoine, AP-HP, Paris, France
| | - Denis Castaing
- Centre National de Référence de la Maladie de Wilson/Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; UMR 785, INSERM, France; UMR-S 785, Univ Paris-Sud, Villejuif, France; DHU Hepatinov, Villejuif, France
| | - Emmanuel Jacquemin
- Centre National de Référence de la Maladie de Wilson/Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; DHU Hepatinov, Villejuif, France
| | - Didier Samuel
- Centre National de Référence de la Maladie de Wilson/Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; UMR 785, INSERM, France; UMR-S 785, Univ Paris-Sud, Villejuif, France; DHU Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Centre National de Référence de la Maladie de Wilson/Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; UMR 785, INSERM, France; UMR-S 785, Univ Paris-Sud, Villejuif, France; DHU Hepatinov, Villejuif, France
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Boudjema K, Camus C, Saliba F, Calmus Y, Salamé E, Pageaux G, Ducerf C, Duvoux C, Mouchel C, Renault A, Compagnon P, Lorho R, Bellissant E. Reduced-dose tacrolimus with mycophenolate mofetil vs. standard-dose tacrolimus in liver transplantation: a randomized study. Am J Transplant 2011; 11:965-76. [PMID: 21466650 DOI: 10.1111/j.1600-6143.2011.03486.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We conducted a multicenter randomized study in liver transplantation to compare standard-dose tacrolimus to reduced-dose tacrolimus with mycophenolate mofetil to reduce the occurrence of tacrolimus side effects. Two primary outcomes (censored criteria) were monitored during 48 weeks post-transplantation: occurrence of renal dysfunction or arterial hypertension or diabetes (evaluating benefit) and occurrence of acute graft rejection (evaluating risk). Interim analyses were performed every 40 patients to stop the study in the case of increased risk of graft rejection. One hundred and ninety-five patients (control: 100; experimental: 95) had been included when the study was stopped. Acute graft rejection occurred in 46 (46%) and 28 (30%) patients in control and experimental groups, respectively (HR = 0.59; 95% CI: [0.37-0.94]; p = 0.024). Renal dysfunction or arterial hypertension or diabetes occurred in 80 (80%) and 61 (64%) patients in control and experimental groups, respectively (HR = 0.68; 95% CI: [0.49-0.95]; p = 0.021). Renal dysfunction occurred in 42 (42%) and 23 (24%) patients in control and experimental groups, respectively (HR = 0.49; 95% CI: [0.29-0.81]; p = 0.004). Leucopoenia (p = 0.001), thrombocytopenia (p = 0.017) and diarrhea (p = 0.002) occurred more frequently in the experimental group. Reduced-dose tacrolimus with mycophenolate mofetil reduces the occurrence of renal dysfunction and the risk of graft rejection. This immunosuppressive regimen could replace full-dose tacrolimus in adult liver transplantation.
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Affiliation(s)
- K Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital de Pontchaillou, Centre Hospitalier Universitaire, Rennes, France.
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63
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Boudjema K, Grandadam S, Compagnon P, Salamé E, Wolf P, Ducerf C, Le Treut P, Soubrane O, Cherqui D, Mouchel C, Renault A, Bellissant E. Efficacy and safety of Celsior preservation fluid in liver transplantation: one-year follow up of a prospective, multicenter, non-randomized study. Clin Transplant 2011; 26:199-207. [PMID: 21517997 DOI: 10.1111/j.1399-0012.2011.01447.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of this prospective, nine-center, non-randomized study was to assess the efficacy and safety of Celsior preservation fluid in liver transplantation using unselected donors. As data comparing allograft outcomes following liver transplantation using Celsior and University of Wisconsin (UW) preservation fluids are limited, we also compared our cohort with matched controls selected from the European Liver Transplant Registry (ELTR) who received total liver grafts preserved with UW solution during the same period. One hundred and forty patients who received livers preserved with Celsior were included. The primary endpoint, graft loss at one-yr post-transplantation, was observed in 24 patients (17.1%) which was not significantly different from the 20.0% pre-defined threshold rate (95% confidence interval [CI] 10.9, 23.4; p=0.398). Predictive factors for graft loss on univariate analysis were moderate-to-severe steatosis on the donor graft (5/22 patients with graft loss vs. 8/107 patients without, p=0.046) and duration of warm ischemia (1.4±1.1 h in patients with graft loss vs. 0.9±0.5 h in patients without, p=0.034). Hepatic artery thrombosis and stenosis occurred in seven (5.0%) and six (4.3%) patients, respectively. The comparison of our patients to 420 ELTR controls showed that one-yr graft survival rates (Celsior: 82.9%, 95% CI 75.8, 88.2; UW: 78.6%, 95% CI 74.4, 82.2) and Kaplan-Meier one-yr graft survival distributions (p=0.285) were similar. Within the cold ischemia time achieved in our study, liver preservation with Celsior appeared efficient and safe. Comparison with ELTR patients suggested that liver allograft survival was similar using Celsior or UW solution for preservation of unselected donor grafts.
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Affiliation(s)
- Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France.
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Ehtisham J, Altieri M, Salamé E, Saloux E, Ollivier I, Hamon M. Coronary artery disease in orthotopic liver transplantation: pretransplant assessment and management. Liver Transpl 2010; 16:550-7. [PMID: 20440764 DOI: 10.1002/lt.22035] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The prevalence of coronary artery disease in end-stage liver disease is only now being recognized. Liver transplant patients are a high risk subgroup for coronary artery disease, even if asymptomatic. Coronary artery disease is a predictor of poor outcomes; therefore, identification of those at risk must be a key clinical priority. However, risk assessment is particularly difficult as many of the available diagnostic tools have either proven to be unhelpful or remain to be validated. Risk factor profiling has been unable to identify those at risk and commonly underestimates risk. The high negative predictive value of Dobutamine stress echo, when target heart rates are achieved, allows it to be used to identify a low risk group. For all other patients, proceeding to invasive coronary angiography is often necessary, and the risks of the procedure can be reduced by a transradial approach. Pharmacological reduction of the consequences of coronary artery disease can be limited by the underlying liver disease. Revascularization pre-transplantation is recommended in international guidelines but has demonstrated little evidence of benefit. Surgical revascularization carries an increased risk in these patients and is commonly performed pre-transplantation, although combined liver and cardiac surgery has been described. Percutaneous coronary intervention is increasingly used with patients requiring anti-platelet medication for up to one year after intervention. We present a review of all these issues and the evidence for assessing and managing these high-risk patients.
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Affiliation(s)
- Javed Ehtisham
- Department of Cardiology, University Hospital of Caen, Normandy, France
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65
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Chiche L, Alkofer B, Parienti JJ, Rouleau V, Salamé E, Samama G, Segol P. Usefulness of follow-up after pancreatoduodenectomy for carcinoma of the ampulla of Vater. HPB (Oxford) 2007; 9:140-5. [PMID: 18333130 PMCID: PMC2020781 DOI: 10.1080/13651820601103829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognosis for carcinoma of the ampulla of Vater (CAV) is better than for pancreatic cancer. The 5-year survival median rate after resection of CAV is 45%, but late recurrences remain possible. Several survival factors have been identified (lymph nodes, perineural invasion), but few data are available on the type of recurrences, their impact and their management. PATIENTS AND METHODS A total of 41 patients treated by pancreatoduodenectomy (PD) for CAV from 1980 to 2003 were studied retrospectively. Patient selection, long-term survival recurrence rate and recurrence treatment were reviewed. Univariate and multivariate proportional hazards analysis were conducted on this series. RESULTS The mean follow-up was 48 months. Five-year survival was 62.8%. Eleven patients had recurrences (6-67 months). Recurrence was associated with time to all-causes death (hazard ratio [HR] 4.3, p=0.003). Factors predictive of recurrence were perineural invasion (HR 5.3, p=0.02), lymph node invasion (HR 5.3, p=0.02) and differentiation (HR 0.2, p=0.05). Three patients underwent surgical R0 treatment of their recurrences. Two who presented with solitary liver metastasis are alive and disease-free. CONCLUSIONS Recurrence represents a serious threat in the prognosis of CAV after surgery. Some of these recurrences, in particular liver metastases, are accessible for a curative treatment. This finding supports the usefulness of a close and long-term follow-up after surgery to improve survival of patients with CAV, especially in the group of patients with a good prognosis.
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Affiliation(s)
- Laurence Chiche
- Hepatobiliary Surgery and Transplantation, CHU CaenCAENFrance
| | - Barbara Alkofer
- Hepatobiliary Surgery and Transplantation, CHU CaenCAENFrance
| | | | | | - Ephrem Salamé
- Hepatobiliary Surgery and Transplantation, CHU CaenCAENFrance
| | - Guy Samama
- General and Laparoscopic Surgery, CHU CaenCAENFrance
| | - Philippe Segol
- Hepatobiliary Surgery and Transplantation, CHU CaenCAENFrance
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Saliba F, Lakehal M, Pageaux GP, Roche B, Vanlemmens C, Duvoux C, Dumortier J, Salamé E, Calmus Y, Maugendre D. Risk factors for new-onset diabetes mellitus following liver transplantation and impact of hepatitis C infection : an observational multicenter study. Liver Transpl 2007; 13:136-44. [PMID: 17192854 DOI: 10.1002/lt.21010] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
New-onset diabetes mellitus (NODM) remains a common complication of liver transplantation (LT). We studied incidence and risk factors in 211 French patients who had undergone a primary LT between 6 and 24 months previously. This is a cross-sectional and retrospective multicenter study. Data were collected on consecutive patients at a single routine post-LT consultation. Demographic details, immunosuppressive regimens, familial and personal histories, hepatitis status, and cardiovascular risk were analyzed to compare those who developed NODM (American Diabetes Association/World Health Organization criteria) with the others. The overall incidence of NODM was 22.7%: 24% in tacrolimus (Tac)-treated patients (n = 175; 82.9%) and 16.7% in cyclosporine-treated patients (n = 36; 17.1%). A total of 81% of the cases were diagnosed within 3 months of LT (M3). Among hepatitis C virus (HCV)-infected (HCV(+)) patients, NODM incidence was 41.7% whereas among those patients negative for this virus (HCV(-)), the incidence was only 18.9% (P = 0.008). In Tac-treated patients, the incidence of NODM in the HCV(+) patients was significantly higher than in the HCV(-) patients (46.7% and 19.3%, respectively, P = 0.0014). Only 1 of 6 (16.7%) of the HCV(+) patients developed NODM on cyclosporine. Other independent pretransplantation risk factors for NODM included impaired fasting glucose (IFG) and a maximum lifetime body-mass index (BMI) over 25 kg/m2. In conclusion, emergence of NODM after LT is related to risk factors that can be detected prior to the graft, like maximum lifetime BMI, IFG, and HCV status. Tac induced a significantly higher incidence of NODM in the HCV(+) compared to the HCV(-) patients. The treatment should therefore be tailored to the patient's risk especially in case of HCV infection.
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Affiliation(s)
- Faouzi Saliba
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre hépato-biliaire, Villejuif, France.
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Salamé E, Neemtallah R, Azar R, Antonios S, Jazra C, Kassab R. [Sensitization of tilt-table testing for syncope of unknown etiology: which drug to use?]. Ann Cardiol Angeiol (Paris) 2006; 55:135-9. [PMID: 16792028 DOI: 10.1016/j.ancard.2005.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The sensitivity of tilt-table testing in the diagnosis of vasovagal syncope is between 30% and 50% only. The most common method currently used to improve the sensitivity of the test is the administration of isoproterenol i.v. However, this method is difficult to perform and time consuming. The objective of our study was to compare sublingual trinitrin administration to i.v. isoproterenol during tilt-table testing. METHODS We analyzed the results of 257 consecutive patients referred for tilt testing. Patients who had a negative test received either a ten minutes infusion of i.v. isoproterenol at the dose of 4 mcg/kg/min, or 0.4 mg of trinitrin given sublingually. RESULTS Two hundred (and) fifty-seven patients underwent tilt-table testing. In the first group (isoproterenol group), 42 patients (39%) had a spontaneous positive tilt test, compared to 45 patients (31%) in the trinitrin group (P = NS). After sensitization, 24 additional patients (22%) had a positive test in the isoproterenol group vs 55 patients (37%) in the trinitrin group (P = NS). The total number of positive tests was 66 (61%) in the isoproterenol group compared to 100 (68%) in the trinitrin group (P = NS). CONCLUSION Sublingual trinitrin is at least as good as IV isoproterenol during tilt-table testing. Because trinitrin is simpler to use and because its administration is much faster than isoproterenol, it should be recommended as the drug of choice to improve the sensitivity of tilt-table testing.
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Affiliation(s)
- E Salamé
- Service de cardiologie, hôpital Hôtel-Dieu-de-France, rue Alfred-Naccache, Beyrouth, Liban.
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Salamé E, Osta H, Antonios S, Abdel-Massih T, Gerbaka B, Kassab R. [Chaotic atrial tachycardia-induced cardiomyopathy: report of an isolated case]. Ann Cardiol Angeiol (Paris) 2005; 54:292-5. [PMID: 16237921 DOI: 10.1016/j.ancard.2005.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chaotic atrial tachycardia is a rare arrhythmia that has no known etiology and that usually inflicts upon newborn infants. The diagnosis is established using the surface electrocardiogram (ECG) which shows a spectacular polymorphism and irregularity of the atrial electrical activity. Clinical tolerability is variable depending on the ventricular rhythm. Cases that are not well tolerated and cases who do not recover spontaneously require medical treatment which relies mainly on amiodarone and other class IC anti-arrhythmic drugs. There is usually complete recovery during the first few months of life. The authors present the case of a female patient who was diagnosed with chaotic atrial tachycardia with induced cardiomyopathy following birth. She was successfully treated with amiodarone but had several relapses of the arrhythmia upon discontinuation of the drug. Although this observation is classic in its presentation, we consider that it is useful to remember this rare and frequently forgotten syndrome and to report the unique and particular aspects of our case and its evolution.
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Affiliation(s)
- E Salamé
- Service de cardiologie, hôpital Hôtel-Dieu de France, rue Alfred-Naccache, Beyrouth, Liban.
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69
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Gloro R, Hourmand-Ollivier I, Mosquet B, Mosquet L, Rousselot P, Salamé E, Piquet MA, Dao T. Fulminant hepatitis during self-medication with hydroalcoholic extract of green tea. Eur J Gastroenterol Hepatol 2005; 17:1135-7. [PMID: 16148563 DOI: 10.1097/00042737-200510000-00021] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite an ancient reputation for potential phytotherapeutic effects and innocuity, traditional herbal medicine has previously been implicated in severe adverse events. Exolise is an 80% ethanolic dry extract of green tea (Camellia sinensis) standardized at 25% catechins expressed as epigallocatechin gallate, containing 5-10% caffeine. It has been available in France, Belgium, Spain and the United Kingdom since 1999, as an adjuvant therapy for use in weight loss programmes. In various studies, green tea has to date been considered useful for its potential hepatic protective properties. In this study, we report a case of fulminant hepatitis during self-medication with Exolise, requiring liver transplantation.
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Affiliation(s)
- Romain Gloro
- Service d'Hépatogastroentérologie et de Nutrition, CHU Côte de Nacre, Caen, France.
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70
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Nashan B, Bock A, Bosmans JL, Budde K, Fijter H, Jaques B, Johnston A, Lück R, Midtvedt K, Pallardó LM, Ready A, Salamé E, Salizzoni M, Suarez F, Thervet E. Use of Neoral C2 monitoring: a European consensus. Transpl Int 2005; 18:768-78. [PMID: 15948854 DOI: 10.1111/j.1432-2277.2005.00151.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Large-scale clinical trials using C(2) monitoring of cyclosporine (CsA) microemulsion (Neoral) in renal transplant recipients have demonstrated low acute rejection rates and good tolerability with a low adverse event profile in a variety of settings: with or without routine induction therapy; in combination with mycophenolate mofetil; with standard-exposure or low-exposure Neoral; and in patients with immediate or delayed graft function. In liver transplantation, C(2) monitoring significantly reduces the severity and incidence of acute rejection compared with C(0) monitoring, without adverse consequences in terms of renal function or tolerability. Different C(2) targets are appropriate depending on adjunctive immune suppression, level of immunologic risk, CsA tolerability, risk of renal toxicity and time since transplantation. CsA absorption may increase substantially in most patients during the first 1-2 weeks post-transplant, and this should be taken into account to avoid overshooting C(2) target range. A patient with a low C(2) value may be either a low or a delayed absorber of CsA, or be a normal absorber who is receiving too low a dose of Neoral. C(2) monitoring alone is insufficient to differentiate between these types of patients, and measurement of additional timepoints is recommended. Adopting C(2) monitoring in maintenance transplant patients identifies those who are overexposed to CsA. In summary, randomized, prospective, multicenter studies and single-center trials have evaluated Neoral C(2) monitoring within a range of regimens in different organ types, providing a robust evidence base for the benefits of this sensitive monitoring technique.
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Affiliation(s)
- Bjorn Nashan
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
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71
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Bénateau H, Alix T, Labbé D, Elissalde JM, Salamé E. Anatomic study of the tendinous insertion lamina of the temporalis muscle. Surg Radiol Anat 2004; 26:281-4. [PMID: 15024608 DOI: 10.1007/s00276-004-0230-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 09/18/2003] [Indexed: 10/26/2022]
Abstract
Lengthening temporalis myoplasty is indicated in long-standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. Knowledge of the anatomy of this strong and wide tendon is necessary for successful use of its anatomic advantages. A study on 10 cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedures: the strong tendon, when freed from the coronoid process, is 4-6 cm wide.
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Affiliation(s)
- H Bénateau
- Department of Maxillo-facial and Plastic Surgery, Centre Hospitalier Universitaire de Caen, Caen, France.
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72
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Salamé E, Goldstein MJ, Kinkhabwala M, Kapur S, Finn R, Lobritto S, Brown R, Emond JC. Analysis of donor risk in living-donor hepatectomy: the impact of resection type on clinical outcome. Am J Transplant 2002; 2:780-8. [PMID: 12243500 DOI: 10.1034/j.1600-6143.2002.20813.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.
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Affiliation(s)
- Ephrem Salamé
- Department of Surgery, CHU Cĵte de Nacre, Caen, France
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73
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Abstract
The periosteum of the temporal area is mentioned at different places in the literature: either against the osseous plane like everywhere in the human body, or between the deep and the superficial temporal fascia. The subperiosteal subtemporal approach in craniofacial surgery in children is in favour of a juxta-osseous localization of the periosteum. Ten premature still-born neonates and two adults cadavers have been dissected for this study and, permit anatomical and histological (with HES coloration) studies. With every specimen, the authors concluded that the temporal periosteum is against the outer table of the calvarium. It became thinner in adults because of direct insertions of the temporalis muscle in the calvaria. An anatomical description of the layers of the temporal area is realised and discussed with an extensive review of the literature. The authors have proposed a subperiosteal subtemporal approach in craniostenosis surgery.
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Affiliation(s)
- H Bénateau
- Service de chirurgie maxillo-faciale et chirurgie plastique, CHU Caen, Av. Côte-de-Nacre, 14033 Caen, France.
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74
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Abstract
The lengthening temporalis myoplasty is indicated in long standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. The knowledge of the anatomy of this strong and wide tendon is necessary to use successfully their anatomical advantages. A study of ten cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedure: the strong tendon, when liberated from the coronoid process, is from 4 to 6 cm long.
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Affiliation(s)
- H Bénateau
- Service de chirurgie maxillo-faciale et plastique, CHU Caen, avenue Côte de Nacre, 14033 Caen, France.
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75
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Chiche L, Salamé E. [Side-to-side porto caval anastomosis with stent]. J Chir (Paris) 2001; 138:32-5. [PMID: 11240459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- L Chiche
- Service de Chirurgie Digestive, Unité de Chirurgie Hépato-biliaire et de Transplantation, CHU Caen Côte de Nacre - Caen
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76
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Abstract
STUDY AIM The aim of this retrospective, nonrandomized study was to compare the results of diverticulectomy and diverticulopexy in the treatment of Zenker's diverticulum. Over the 10-year period between 1988 and 1998, surgery for Zenker's diverticulum was performed in 40 patients. PATIENTS AND METHOD The study group consisted of 23 men and 17 women with a mean age of 72 years. Only 39 patients were evaluated. In 19 patients, treatment consisted of cricopharyngeal myotomy and diverticulum suspension; in the other 19 patients, treatment consisted of diverticulectomy in addition to myotomy. Only one patient had a diverticulectomy without myotomy. RESULTS There was no mortality and the morbidity rate was low: one fistula, one pneumonia, three cases of transient dysphonia and one hematoma. The results were excellent in 36 patients, and good in 3 patients. CONCLUSION Cricopharyngeal myotomy with diverticulopexy is particularly suitable for geriatric patients. Diverticulectomy is proposed in the case of a diverticulum larger than 6 cm and for young patients to prevent the risk of malignant transformation.
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Affiliation(s)
- J Leporrier
- Service de chirurgie générale et digestive, CHU Côte-de-Nacre, 14033 Caen, France
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77
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Chiche L, Dao T, Salamé E, Galais MP, Bouvard N, Schmutz G, Rousselot P, Bioulac-Sage P, Ségol P, Gignoux M. Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature. Ann Surg 2000; 231:74-81. [PMID: 10636105 PMCID: PMC1420968 DOI: 10.1097/00000658-200001000-00011] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Liver adenomatosis (LA) is a rare disease originally defined by Flejou et al in 1985 from a series of 13 cases. In 1998, 38 cases were available for analysis, including eight personal cases. The aim of this study was to review and reappraise the characteristics of this rare liver disease and to discuss diagnosis and therapeutic options. BACKGROUND LA was defined as the presence of >10 adenomas in an otherwise normal parenchyma. Neither female predominance nor a relation with estrogen/progesterone intake has been noted. Natural progression is poorly known. METHODS The clinical presentation, evolution, histologic characteristics, and therapeutic options and results were analyzed based on a personal series of eight new cases and an updated review of the literature. RESULTS From a diagnostic standpoint, two forms of liver adenomatosis with different presentations and evolution can be defined: a massive form and a multifocal form. The role of estrogen and progesterone is reevaluated. The risks of hemorrhage and malignant transformation are of major concern. In the authors' series, liver transplantation was indicated in two young women with the massive, aggressive form, and good results were obtained. CONCLUSION Liver adenomatosis is a rare disease, more common in women, where outcome and evolution vary and are exacerbated by estrogen intake. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.
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Affiliation(s)
- L Chiche
- Department of Hepatobiliary Surgery, University Hospital of Caen, France
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Salamé E, Chereau C, Calmus Y, Ayani E, Houssin D, Weill B. [Superacute xenogenic rejection: attempted treatment with anti-idiotypic antibodies]. Presse Med 1992; 21:1945-6. [PMID: 1294946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Heart xenotransplantation in the guinea-pig to rat model, a highly discordant combination, is invariably followed by a hyperacute rejection of the graft. Preformed IgMs were shown to be responsible for the destruction of the graft by stimulating the complement cascade. We tried to inhibit preformed antibodies, before transplantation, by inducing anti-idiotypic antibodies using autologous Fab' mu specific for guinea-pig endothelial cells. This treatment seems to exert a neutralizing effect on xenogeneic hyperimmunization, against guinea-pig endothelial cells but not against preformed anti-guinea-pig antibodies.
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Affiliation(s)
- E Salamé
- Laboratoire de Recherche Chirurgicale et d'Immunologie, UER Cochin Port Royal, Paris
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79
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Gambiez L, Salamé E, Chéreau C, Calmus Y, Ayani E, Houssin D, Weill B. Natural IgM play a major role in hyperacute rejection of discordant heart xenografts. Transplant Proc 1992; 24:441-2. [PMID: 1566380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- L Gambiez
- Laboratoire d'Immunologie, Faculté Cochin, Paris, France
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